Provider Demographics
NPI:1730480773
Name:BENVENUTI, LEA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MARIE
Last Name:BENVENUTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:MARIE
Other - Last Name:ALBERGHINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:ME
Mailing Address - Zip Code:04667
Mailing Address - Country:US
Mailing Address - Phone:207-853-0644
Mailing Address - Fax:207-853-2347
Practice Address - Street 1:11 BACK ROAD
Practice Address - Street 2:
Practice Address - City:PLEASANT POINT
Practice Address - State:ME
Practice Address - Zip Code:04667
Practice Address - Country:US
Practice Address - Phone:207-853-0644
Practice Address - Fax:207-853-2347
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008025197Medicaid